Healthcare Provider Details

I. General information

NPI: 1407717317
Provider Name (Legal Business Name): WILD GEESE PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 3RD AVE STE 312
HAVRE MT
59501-3577
US

IV. Provider business mailing address

305 3RD AVE STE 312
HAVRE MT
59501-3577
US

V. Phone/Fax

Practice location:
  • Phone: 406-201-5679
  • Fax:
Mailing address:
  • Phone: 406-201-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTINA YEAGLEY
Title or Position: OWNER
Credential: PSY.D.
Phone: 406-201-5679